| NPI | 1033943469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NA) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| 103TH0100X Psychologist, Health Service (Licence: an) | |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-08-28 |