| NPI | 1952465197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 0943) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NM 0943) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM NM 0010C) | |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0008) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2015-06-03 |