| NPI | 1487883187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00032844) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 32844) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-11843) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2016-04-18 |