| NPI | 1982890489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA md60763215) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA01265) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2019-08-29 |