| NPI | 1770774176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00002203) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM PSY-RXP0065) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2025-09-26 |