| NPI | 1780638031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00027945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00027945) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: WA 00027945) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2022-08-31 |