| NPI | 1578172698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports (Licence: PA PS019503) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2022-01-20 |