| NPI | 1831290360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA AS1019000) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA AS1019000) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-03-31 |