| NPI | 1932698305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 81704) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: VA 2201001811) |
| 231H00000X Audiologist (Licence: CO AUD.0000861) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2025-04-03 |