| NPI | 1972622819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WA 60041432) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: AK 80) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-10-15 |