| NPI | 1164439600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0012C) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 0882) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-04-19 |