Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner |
NPI | 1316204274 |
---|---|
Provider Name | Marcus Weight |
First Address | San Diego, CA 92198-2492 |
Second Address | San Diego, CA 92128-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2012 |
Last Update Date | 17/04/2012 |