| NPI | 1326084328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: WA MD60248946) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD18328) |
| 207Q00000X Family Medicine (Licence: OR MD18328) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2012-08-02 |