| NPI | 1619419439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: LA 326468) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: LA 1591) |
| 103TC0700X Psychologist Clinical (Licence: IN 20042989A) | |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2022-11-17 |