| NPI | 1760298152 |
|---|---|
| Former Name | JESSIE LYCANS |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist |
| Additional Taxonomies | 231H00000X Audiologist |
| 237700000X Hearing Instrument Specialist | |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2024-12-10 |