| NPI | 1194858654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: PA AT000421L) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NJ 25MG00057900) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-10 |