| NPI | 1164196929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201001878) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KY 271232) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2023-09-07 |