| NPI | 1457692121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WA LD61019715) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: CT 531) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2020-12-17 |