| NPI | 1639126238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD000014180) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00014180) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD00014180) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2015-06-18 |