| NPI | 1902296130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 91705944101) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: WY A1005) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: WY A1005) | |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: UT 91705944101) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2025-02-27 |