| NPI | 1497029318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: OR 22152) |
| Additional Taxonomies | 231HA2500X Audiologist, Assistive Technology Supplier (Licence: OR 22152) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: OR 22152) | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2012-02-24 |