| NPI | 1659340735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 75603-20) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00048863) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD00048863) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD151136) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OR MD151136) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-01-07 |