| NPI | 1073506226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO R0244) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: MO R0244) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2010-12-21 |