Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | 85872 | DC |
NPI | 1538632435 |
---|---|
Provider Name | Mr. Patrick Brian Boardman |
First Address | Missouri City, TX 77459-4522 |
Second Address | Missouri City, TX 77459-4522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 03/01/2019 |