| NPI | 1629630884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: CO 0000968) |
| Additional Taxonomies | 231HA2400X Audiologist Assistive Technology Practitioner (Licence: CO 0000968) |
| 231HA2500X Audiologist Assistive Technology Supplier (Licence: CO 0000968) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: CO 0000968) | |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2019-07-08 |