| NPI | 1942789540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X |
| Additional Taxonomies | 225CA2500X Rehabilitation Counselor, Assistive Technology Supplier (Licence: TX 86754) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2024-01-15 |