| NPI | 1649289919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP0837) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA 837) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-04-01 |