| NPI | 1801978887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 546) |
| Additional Taxonomies | 103TP0016X Psychologist Prescribing (Medical) (Licence: NM 0004) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2013-03-28 |