| NPI | 1639762099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other |
| Additional Taxonomies | 225CA2400X Rehabilitation Counselor Assistive Technology Practitioner |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2024-10-04 |