| NPI | 1952542219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MO 2009007671) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: GA 001286) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2009-05-07 |