| NPI | 1245495415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: FL AY1487) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: AZ DA5923) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: AZ DA5923) | |
| Enumeration Date | 2008-07-27 |
| Last Update Date | 2012-07-24 |