| NPI | 1205121001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101263191) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD33615) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61148741) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: WA MD61148741) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2023-10-12 |