| NPI | 1487408266 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 81720) | 
| Additional Taxonomies | 231H00000X Audiologist (Licence: CA 3875) | 
| Enumeration Date | 2024-04-16 | 
| Last Update Date | 2024-05-19 |