NPI | 1376905661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME144395) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2016-03-24 |
Last Update Date | 2020-06-26 |