| NPI | 1629006358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61576549) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 61576549) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 183492-1205) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2025-08-30 |