| NPI | 1073688073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: NY 115291) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 115291) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2023-03-31 |