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 |