| NPI | 1700850344 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 80518)  | 
| Additional Taxonomies | 231HA2400X Audiologist, Assistive Technology Practitioner (Licence: TX 80518)  | 
| 237600000X Audiologist-Hearing Aid Fitter (Licence: TX 80518)  | |
| Enumeration Date | 2006-02-13 | 
| Last Update Date | 2015-02-06 |