| NPI | 1114615465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225CA2400X Rehabilitation Counselor Assistive Technology Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2023-04-25 |