| NPI | 1316439904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201001740) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: DC AUD000196) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2019-07-16 |