NPI | 1710103155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: MP.000019) |
Additional Taxonomies | 103T00000X Psychologist (Licence: LA 982) |
Enumeration Date | 2007-04-17 |
Last Update Date | 2019-08-16 |