| NPI | 1407254964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX ATP 7744) |
| 225CA2400X Rehabilitation Counselor, Assistive Technology Practitioner (Licence: TX ATP 7744) | |
| 225CA2500X Rehabilitation Counselor, Assistive Technology Supplier (Licence: TX ATP 7744) | |
| 225CX0006X (Licence: TX ATP 7744) | |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2020-05-06 |