| NPI | 1093743528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MPAP.000015) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 304) |
| 103TF0200X Psychologist, Forensic (Licence: LA 304) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: LA 304) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2013-12-04 |