| NPI | 1467623421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NC 11105) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: PA AT005915) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2017-01-10 |