| NPI | 1073027066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 0005213) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: CO 0005213) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2022-12-02 |