| NPI | 1124120761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00047157) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD00047157) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WA MD00047157) | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: WA MD00047157) | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: WA MD00047157) | |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: WA MD00047157) | |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2021-06-10 |