| NPI | 1275501439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WV A0074) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VA 2201000219) |
| 231H00000X Audiologist (Licence: WV 447) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2013-05-23 |