| NPI | 1811155773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60644353) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: WA MD60644353) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WA MD60644353) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2023-09-06 |