| NPI | 1043666506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 321492) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2020-01-01 |