| NPI | 1659763639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: OR 30819) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: UT 8761825-4101) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2019-11-20 |