| NPI | 1033260849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP000033) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 665) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2014-01-17 |