| NPI | 1609818905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: 5935522-4101) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: UT 5935522-4101) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2012-02-15 |