| NPI | 1376530279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM PSY1507) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PR 02334) |
| 103TC0700X Psychologist, Clinical (Licence: PR 2334) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2023-06-04 |