| NPI | 1154310118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: IL 147.001175) |
| Additional Taxonomies | 231HA2500X Audiologist, Assistive Technology Supplier (Licence: IL 147.001175) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: IL 147.001175) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2008-01-31 |