| NPI | 1255622262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: IA 0003) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 001265) |
| 103TH0100X Psychologist, Health Service (Licence: IA 000601) | |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: IA 001265) | |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2022-02-03 |