| NPI | 1528338092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: HI MD-4797) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI MD-4797) |
| Enumeration Date | 2011-12-30 |
| Last Update Date | 2011-12-30 |