NPI | 1407252604 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: LA 300762) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: LA 1247) |
103TR0400X Psychologist Rehabilitation (Licence: LA 1247) | |
Enumeration Date | 2014-11-15 |
Last Update Date | 2016-02-06 |