| NPI | 1336596261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 237700000X Hearing Instrument Specialist (Licence: GA HAA000150) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT001625) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2019-10-01 |