| NPI | 1982800033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A88885) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00047002) |
| 208D00000X General Practice (Licence: CA A88885) | |
| 208D00000X General Practice (Licence: WA MD00047002) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2007-07-08 |