| NPI | 1790459527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 83054) |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2021-10-26 |