| NPI | 1336210871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MD 00172) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VA 2201000146) |
| 282N00000X General Acute Care Hospital (Licence: DC AUD000055) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2014-05-16 |