| NPI | 1609112432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255R0406X Specialist/Technologist, Rehabilitation, Blind (Licence: NY 785484971) |
| Additional Taxonomies | 225CX0006X Rehabilitation Counselor, Orientation and Mobility Training Provider (Licence: AZ 1938) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2012-12-27 |