| NPI | 1184028896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 5536) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2026-03-13 |