| NPI | 1912319500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: IA 000777) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: IA 076137) |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2018-03-17 |