| NPI | 1518245455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225CA2400X Rehabilitation Counselor, Assistive Technology Practitioner (Licence: TX 92775) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1208207) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2020-10-19 |