| NPI | 1821025495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports (Licence: OR 1491) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: OR 1491) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2007-07-08 |