| NPI | 1487647384 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 458) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 458) |
| 103T00000X Psychologist (Licence: NM 458) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2013-05-02 |