| NPI | 1912290099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X (Licence: TX 00965268) |
| Additional Taxonomies | 225CA2400X Rehabilitation Counselor, Assistive Technology Practitioner (Licence: TX 00965268) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2011-05-23 |