| NPI | 1164585162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00016720) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: WA MD00016720) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD00016720) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |