| NPI | 1326331521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60797252) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD60797252) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2023-03-14 |