| NPI | 1720020159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MPAP.000010) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA MPAP.000010) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: LA MPAP.000010) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2010-09-17 |