| NPI | 1073689378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP.000037) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 523) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2016-12-05 |