| NPI | 1154391068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MS A3324) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KY 0100) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2014-01-31 |