| NPI | 1164689683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201000223) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: VA 2101000261) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-05-21 |