| NPI | 1255521779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: OR 20346) |
| Additional Taxonomies | 332S00000X Hearing Aid Equipment (Licence: OR HASP855737) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2007-07-31 |