NPI | 1245560036 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 306387) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1117) |
Enumeration Date | 2009-12-30 |
Last Update Date | 2023-07-21 |