| NPI | 1457474983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 443MP) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: LA 443MP) |
| 103TC0700X Psychologist, Clinical (Licence: LA 443MP) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 443MP) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2016-12-20 |