| NPI | 1326012949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.204595) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX M1667) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2022-08-29 |