| NPI | 1104160910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0036) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY21256) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2016-09-14 |