| NPI | 1669640777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP.000036) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 47818) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2015-06-04 |