| NPI | 1750617338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201000166) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: VA 2102002474) |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2009-11-02 |