| NPI | 1235211798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 606MP) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA 606MP) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2019-10-22 |