| NPI | 1134548233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101264913) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101264913) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2022-03-08 |