| NPI | 1619360138 |
|---|---|
| Former Name | MICHAEL LEONARD GREEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 302051) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 05283) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2022-11-17 |