| NPI | 1972593861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NY 002506) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 001231) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: NY 001231) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2007-07-08 |