| NPI | 1104953769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MPAP.000033) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA MP.0953) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2014-07-18 |