| NPI | 1184702151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3587) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 3587) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NC 3587) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2010-09-14 |