| NPI | 1841417607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 000685-01) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VT 145.0117582) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: NY 14000079016) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2025-03-21 |