| NPI | 1821356932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60739555) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60739555) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2023-11-02 |