| NPI | 1902237266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: ID PSY-203789) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WI 3121-57) |
| 103TC0700X Psychologist Clinical (Licence: ID PSY-203789) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2025-04-23 |