| NPI | 1710014873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP.000577) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA MP577) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2019-04-04 |