| NPI | 1265675169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: CT 000236) |
| Additional Taxonomies | 231HA2400X Audiologist Assistive Technology Practitioner (Licence: CT 000236) |
| 231HA2500X Audiologist Assistive Technology Supplier (Licence: CT 000236) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2009-04-08 |