| NPI | 1700258308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: PA AT006491) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: HI AUD157) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2018-05-04 |