| NPI | 1508075607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: AZ DA1304) |
| Additional Taxonomies | 231HA2400X Audiologist Assistive Technology Practitioner (Licence: AZ DA1304) |
| 231HA2500X Audiologist Assistive Technology Supplier (Licence: AZ DA1304) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: AZ DA1304) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2008-10-15 |