| NPI | 1104181064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41YS00632100) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2022-08-10 |