| NPI | 1275530115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MN 5119) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: WI 94156) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: MN 2017) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2010-11-15 |