| NPI | 1982268595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports (Licence: TX 15276) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 15276) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-04-29 |