| NPI | 1689754012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MD 01467) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VA 2201000526) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-01-18 |