| NPI | 1467738617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-20270) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA10502700) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-79647) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME142842) | |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2021-05-17 |