| NPI | 1902041825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS015087) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: PA PS015087) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2020-02-08 |