| NPI | 1619307329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 3563909) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: NY 3563909) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-18 |