| NPI | 1679615900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 000244-1) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: NY 14000010454) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |