| NPI | 1568401065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: PA PS015793) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS015793) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-10-21 |