| NPI | 1548523285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 60762771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60762771) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: WA 60762771) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2021-02-10 |