| NPI | 1104695402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other (Licence: TX 96757) |
| Additional Taxonomies | 225CA2500X Rehabilitation Counselor, Assistive Technology Supplier (Licence: TX 96757) |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2024-04-29 |