| NPI | 1093934440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 301888) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003080) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-07-08 |