| NPI | 1639530769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OK 6232) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OK 6232) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 6232) | |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2022-06-30 |