| NPI | 1982215695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 2544) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2024-07-16 |