| NPI | 1780679324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MO 2008020593) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: TX 51508) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: MO 2008020593) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2020-04-14 |