| NPI | 1669595823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 104292-4101) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: MI 3501004519) |
| 231H00000X Audiologist (Licence: MI 1601000078) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: 1601000078) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2019-11-21 |