| NPI | 1366118598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X |
| Additional Taxonomies | 225CA2400X Rehabilitation Counselor, Assistive Technology Practitioner (Licence: TX 93846) |
| 247200000X (Licence: TX 93846) | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2023-03-02 |