| NPI | 1225188378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: IA 20) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: IA 67) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: IA 238) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-12-10 |