| NPI | 1164859963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: CT 031148) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 031148) |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2013-10-11 |