| NPI | 1164771168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 330644) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2023-02-05 |