Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner |
NPI | 1639762099 |
---|---|
Provider Name | Mr. Michael Lucero |
First Address | Saint Charles, MO 63301-3708 |
Second Address | El Paso, TX 79935-5006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2021 |
Last Update Date | 17/02/2021 |