| NPI | 1376524793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: NM 0013) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM 142) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2013-05-16 |