| NPI | 1255803292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: NY 216775031) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: NY 121716021) |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2018-12-31 |