| NPI | 1780605618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: IN 07155) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 173000000X Legal Medicine (Licence: MO ABFM-380) | |
| 174400000X Specialist (Licence: NV 01474) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2025-02-21 |