| NPI | 1285767145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0018) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 541) |
| 103TH0004X Psychologist, Health (Licence: NM 541) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2013-04-25 |