| NPI | 1619612942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0102208162) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102208162) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2026-06-22 |