| NPI | 1316281330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: PA AT006272) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: WV A-0299) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2015-12-01 |