| NPI | 1194875880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: LA 56) |
| Additional Taxonomies | 231HA2500X Audiologist Assistive Technology Supplier (Licence: LA 56) |
| 235Z00000X Speech-Language Pathologist (Licence: LA 56) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: LA 56) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2011-01-04 |