| NPI | 1275083651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: GA AUD004125) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: WY A-1012) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2020-05-18 |