| NPI | 1396837571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WY AUDIOLOGY A904) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: WY HEARING AID FILTER) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-09 |