| NPI | 1780668053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MT 1279) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NV A007) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2016-05-06 |