| NPI | 1235117813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD27984) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00048916) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: OR MD27984) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: WA MD00048916) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2013-03-01 |