| NPI | 1285639807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WY A-963) |
| Additional Taxonomies | 231HA2400X Audiologist Assistive Technology Practitioner (Licence: WY A963) |
| 231HA2500X Audiologist Assistive Technology Supplier (Licence: WY A963) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: WY A963) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2020-10-16 |