| NPI | 1669501136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 322138) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 1187) |
| 103T00000X Psychologist (Licence: TN 2800) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-05-31 |