| NPI | 1982385472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM PSY-2023-0072) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM 0923) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2023-07-27 |