| NPI | 1861599912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: ID AUD-1128) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: WY A-998) |
| 231HA2500X Audiologist, Assistive Technology Supplier (Licence: ID AUD-1128) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-03-18 |