| 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 |