| NPI | 1245887785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: UT 10524090-2501) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2019-08-20 |