| NPI | 1215927256 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ACN952) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 6244) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2020-04-09 |