| NPI | 1508380445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MN LICC-1961) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: WV A-0335) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2026-03-17 |