| NPI | 1770575268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201000150) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: VA 2101000334) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2012-08-01 |