| NPI | 1609043942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 016330-1) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: NY 16330) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2023-06-30 |