| NPI | 1760621460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MT 1284) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: CO AUD400) |
| 237600000X Audiologist-Hearing Aid Fitter | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: MT 408) | |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2011-06-22 |