| NPI | 1649370495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 722 MP) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: LA 722 MP) |
| 103TC0700X Psychologist, Clinical (Licence: LA 722 MP) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 722 MP) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 722 MP) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-05-12 |