| NPI | 1174800510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NM AUD7192) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: AZ DA12508) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: AZ DA12508) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2020-10-13 |