| NPI | 1952379380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MO 2003019973) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MO 12006502) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: MO 2005034032) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2021-03-05 |