| NPI | 1255642021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 237600000X Audiologist-Hearing Aid Fitter (Licence: TX 80363) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VA 2201001431) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2022-01-25 |