Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | 75739 | TX |
NPI | 1427407436 |
---|---|
Provider Name | Byron Wallace |
First Address | Mckinney, TX 75070-6754 |
Second Address | Mckinney, TX 75070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 09/06/2016 |