| NPI | 1700200722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: NM 1233) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0047c) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2022-10-21 |