| NPI | 1174216089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: GA PSY004644) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: GA PSY004644) |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2023-05-29 |