| NPI | 1518907278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 367) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO PYR0261) |
| 103TC0700X Psychologist, Clinical (Licence: TX 2-1983-2) | |
| 103TC0700X Psychologist, Clinical (Licence: LA 367) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-01-17 |