| NPI | 1760799886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 334132) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY9350) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY9350) | |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2025-04-11 |