| NPI | 1366964132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM OT4615) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2024-04-30 |