NPI | 1164565545 |
---|---|
Former Name | ANDREA S WAGNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 231H00000X Audiologist (Licence: TX 80257) |
Additional Taxonomies | 231H00000X Audiologist (Licence: MD 01105) |
Enumeration Date | 2007-02-15 |
Last Update Date | 2012-08-13 |