| NPI | 1750463782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 10) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: PA AT000514L) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2013-11-07 |