| NPI | 1518097021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: IA 00393) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: IA 00679) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |