| NPI | 1710316575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 002500) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NJ 41YA00086900) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2014-07-03 |