| NPI | 1821837089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101290149) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2026-09-18 |