| NPI | 1003065749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0040C) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60201752) |
| 103TC0700X Psychologist, Clinical (Licence: NM 1296) | |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2017-02-28 |