| NPI | 1790749000 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301028146) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2022-06-21 |