| NPI | 1427637990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: UT 0454) |
| Additional Taxonomies | 251300000X Local Education Agency (LEA) |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2021-04-03 |