| NPI | 1902147853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NC 10758) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MD 01282) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: MD 01282) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: NC 10758) | |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2014-07-14 |