| NPI | 1992059786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: SC 4145) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: OR 23525) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2021-06-03 |