| NPI | 1396812376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: SC 249) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: GA AUD000296) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-08 |