| NPI | 1548551278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: SC 159AMP) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 45428) |
| 101YP1600X Counselor, Pastoral (Licence: SC 61388) | |
| 103G00000X Clinical Neuropsychologist (Licence: SC 573768) | |
| 171000000X Military Health Care Provider (Licence: SC 159AMP) | |
| 171W00000X Contractor (Licence: SC 73276) | |
| 174H00000X Health Educator (Licence: SC 73276) | |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: SC 5768) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 159AMP) | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2020-07-08 |