| NPI | 1285385815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM OT-2024-0054) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 235Z00000X Speech-Language Pathologist, (Licence: NM SLP7471) | |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-08-22 |