| NPI | 1548247075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OR 19404) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR 19404) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD000036270) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD000036270) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2011-06-03 |