| NPI | 1306041991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 726) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports |
| 103TC0700X Psychologist Clinical (Licence: NC 726) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2007-07-08 |