| NPI | 1134287048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 01638) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810002985) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP.1016) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2012-01-03 |