| NPI | 1497002604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: FL AY1752) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL AZ628) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2019-08-13 |