| NPI | 1255465886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0033) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 213) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2014-03-31 |