| NPI | 1922001643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: AL 817a) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: TX 51486) |
| 231H00000X Audiologist (Licence: NC 5652) | |
| 231H00000X Audiologist (Licence: MS A2835) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2008-05-19 |