| NPI | 1063843373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 3766) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: PR 3766) |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2013-12-12 |