Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1003290933 |
---|---|
Provider Name | Mr. Dirk Evans |
First Address | San Diego, CA 92117-1203 |
Second Address | Minneapolis, MN 55417-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2015 |
Last Update Date | 09/07/2015 |