NPI | 1225260961 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
Enumeration Date | 2009-08-13 |
Last Update Date | 2020-07-13 |