| NPI | 1972624286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: WI 748-156) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: MN 6055) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2021-09-16 |