| NPI | 1275828543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225CA2400X Rehabilitation Counselor Assistive Technology Practitioner |
| Additional Taxonomies | 247200000X Technician, Other (Licence: TX ATP1625) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2023-01-23 |