| NPI | 1548932106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 5457) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: 462) |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2022-03-14 |