| NPI | 1689620320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00042194) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD00042194) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: WA MD00042194) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2013-07-17 |