| NPI | 1871773382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MI 1601000449) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: MI 3501002908) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2008-04-08 |