| NPI | 1134680374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61206526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61206526) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-03-01 |