| NPI | 1518961382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD00014747) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: WA 14747) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-02-10 |