| NPI | 1750761847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 325198) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA 1323) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2020-12-21 |