| NPI | 1871892323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00691400) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2019-10-09 |