| NPI | 1104865666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD00045891) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00045891) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-10-05 |