| NPI | 1699929877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: NY 009597-1) |
| Additional Taxonomies | 251E00000X Home Health (Licence: NY 009597-1) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2008-11-13 |