| NPI | 1871571232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA MD60527976) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: UT 159944-1205) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2022-07-21 |