| NPI | 1699178541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: FL 590839562) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2018-05-08 |