| NPI | 1780727768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60341543) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 60341543) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA 60341543) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60341543) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-08-07 |