| NPI | 1881138410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: ID 5971567) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: ID 5971567) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2025-12-22 |