| NPI | 1003556887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 70131231) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE TEP9317) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-07-22 |