Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP4732 | TX |
NPI | 1225320492 |
---|---|
Provider Name | Mr. Fred J Urbanovsky |
First Address | Round Rock, TX 78681-1437 |
Second Address | Round Rock, TX 78681-1437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 06/05/2011 |