| NPI | 1124301965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 8106522-4101) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: IL 147001406) |
| 231H00000X Audiologist (Licence: TX 80442) | |
| 231H00000X Audiologist (Licence: OK 4168) | |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2014-09-08 |