| NPI | 1376066712 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MO 2017033354) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KS 2326) |
| 231H00000X Audiologist (Licence: CA 3260) | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2021-07-02 |