| NPI | 1770163404 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NJ 41YA00066000) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: NJ 25MG00103900) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2021-04-08 |