| NPI | 1174957906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MO 2013028792) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KS 2289) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2024-03-26 |