| NPI | 1164655262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: ID AUD-1422) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: ID AUD-1422) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2011-03-03 |