| NPI | 1346573565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP.0024) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY1096) |
| 103TC0700X Psychologist, Clinical (Licence: LA 1109) | |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2012-12-03 |