| NPI | 1508061169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM PSY-RXP0053) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 1290) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0039C) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2023-03-07 |