| NPI | 1174767347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MN LICC-773) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MN 8448) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2026-03-17 |