| NPI | 1811249873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 00002436-1) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: NY 14000036042) |
| 237700000X Hearing Instrument Specialist (Licence: NY 14000036042) | |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2012-10-15 |