| NPI | 1821508060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255R0406X Specialist/Technologist Rehabilitation, Blind |
| Additional Taxonomies | 225CX0006X Rehabilitation Counselor Orientation and Mobility Training Provider |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2017-10-02 |