NPI | 1598912032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
Additional Taxonomies | 174400000X Specialist (Licence: PR 879) |
Enumeration Date | 2008-08-27 |
Last Update Date | 2018-08-15 |