| NPI | 1548500838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 2736) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: TN 2736) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2013-05-08 |