| NPI | 1881235505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: VA 2201001761) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NY 002905) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: VA 2101002511) | |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2021-03-25 |