| NPI | 1679905004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: OH A.01903) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VA 2201001513) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2015-05-18 |