| NPI | 1568541803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C134507) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AL 25389) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2019-05-03 |