| NPI | 1356303705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NJ 41YA00069900) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: PA AT005975) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: NJ 25MG00104200) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2007-07-08 |