| NPI | 1376172932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A204278) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-02-17 |