| NPI | 1518022920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G76979) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2025-10-06 |