| NPI | 1649592338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 225CA2400X Rehabilitation Counselor Assistive Technology Practitioner |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2010-02-26 |