| NPI | 1750655940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: SD AUD009) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MN AUD8264) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2016-09-26 |