| NPI | 1043666506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: LA 340254) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2025-04-11 |