| NPI | 1609879147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 506) |
| Additional Taxonomies | 231HA2400X Audiologist, Assistive Technology Practitioner (Licence: NY 506) |
| 231HA2500X Audiologist, Assistive Technology Supplier (Licence: NY 506) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: NY 506) | |
| Enumeration Date | 2005-05-28 |
| Last Update Date | 2012-01-04 |