| NPI | 1164071205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WA 60996830) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: WA 60996830) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2023-09-27 |