| NPI | 1851504575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS016068) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS016068) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: PA PS016068) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |