| NPI | 1053823799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: 932490151) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 932490151) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2017-11-03 |