| NPI | 1992703599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 231H00000X Audiologist (Licence: PA AT0002281) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: NJ 41YA00045200) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2008-07-07 |