| NPI | 1679205678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225CA2400X Rehabilitation Counselor Assistive Technology Practitioner (Licence: 95655) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-07-05 |