| NPI | 1568791143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD61199734) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: TN 50513) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TN 50513) | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: TN 50513) | |
| 208D00000X General Practice (Licence: TN 50513) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2024-10-11 |