| NPI | 1568267094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| 227900000X Respiratory Therapist, Registered | |
| Enumeration Date | 2025-02-18 |
| Last Update Date | 2025-02-18 |