| NPI | 1376500413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NC 6885) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 6885) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: NC 6885) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2021-03-31 |