| NPI | 1841607405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MO 2014019509) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: KS 2259) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2022-04-19 |