| NPI | 1114005584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60191191) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 228522) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60191191) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-05-17 |