| NPI | 1265250138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OK 1470) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: OK 1470) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-09-30 |