| NPI | 1982647145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: UT 8471398-4104) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: UT 8471398-4101) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-02-04 |