| NPI | 1790976488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: AR 431) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: LA 5734) |
| 231H00000X Audiologist (Licence: NM 4030) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2019-07-24 |