| NPI | 1508380445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MN 10127) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: WV A-0335) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-07-21 |