| NPI | 1043740103 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 449) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CO 449) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2018-10-23 |