| NPI | 1558407932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0026) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 33523) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-03-24 |