| NPI | 1881972610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: ID PSY-203389) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2076) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2025-08-13 |