| NPI | 1316147085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A6059) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2025-10-06 |