| NPI | 1477176220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61440664) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA MD61440664) |
| 207R00000X Internal Medicine (Licence: WA MD61440664) | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2026-03-12 |