| NPI | 1417205196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201001770) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: SC 7963) |
| 231H00000X Audiologist (Licence: NY 14000033600) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2024-04-30 |