| NPI | 1790564094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 1732639232) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: NY 1732640232) |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2023-09-26 |