| NPI | 1205151511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231HA2400X Audiologist Assistive Technology Practitioner (Licence: VA 2201000535) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: VA 2101000859) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2010-03-30 |