| NPI | 1417195843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 002195-1) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NJ 41YA00075100) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2011-03-03 |