NPI | 1598143406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A147642) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2015-05-12 |
Last Update Date | 2024-06-17 |