| NPI | 1265615512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 237600000X Audiologist-Hearing Aid Fitter (Licence: MO 118419) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: IL 147.001261) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2018-01-11 |