| NPI | 1336295864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: WA MD00048010) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00048010) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WA MD00048010) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00048010) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2015-07-16 |