| NPI | 1982957817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: ID aud2246) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: UT 97419074101) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2019-03-07 |