| NPI | 1962444901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 1022) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 952) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 1022MP) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2015-11-04 |