| NPI | 1346397387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: NM 0042) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: GA PSY002308) |
| 103TC0700X Psychologist Clinical (Licence: NM 1251) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2017-09-13 |