| NPI | 1528682077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM OT-2024-0049) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-01-29 |