| NPI | 1699119156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: FL SS 754) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2013-04-26 |