| NPI | 1225283260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 48431) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A133155) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 49742) | |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: CO 48431) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2022-02-18 |