| NPI | 1801633672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MD 07069) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: MD 07069) |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2024-07-10 |