| NPI | 1225029150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA OP61116455) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA OP61116455) |
| 207Q00000X Family Medicine (Licence: WA OP61116455) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: HI DOS-984) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-08-19 |