| NPI | 1700925807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 001678) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: NY 14000009853) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2014-05-12 |