| NPI | 1992991517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 2747) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2021-11-12 |