| NPI | 1366736670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: WA ML61252381) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA TR60182571) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2021-12-21 |