| NPI | 1245716588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WA LD61427981) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NJ 41YA00112200) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: WA LD61427981) | |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2023-07-18 |