| NPI | 1366970634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: OH 02071) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MI 1962757583) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2024-10-31 |