| NPI | 1124256839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: CT 000478) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: CT 000478) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2012-04-13 |