Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP89462 | TX |
NPI | 1659869832 |
---|---|
Provider Name | Mr. Donald Jay Moss JR. |
First Address | Hurst, TX 76053 |
Second Address | Hurst, TX 76053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 24/04/2018 |