Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | ATP 44298 | |
N | 225CA2500X | Assistive Technology Supplier | ATP 44298 |
NPI | 1356624738 |
---|---|
Provider Name | Mr. Dustin James Boling |
First Address | Austin, TX 78752-1016 |
Second Address | Austin, TX 78752-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2011 |
Last Update Date | 05/09/2013 |