NPI | 1255511168 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 071006228) |
Enumeration Date | 2007-11-08 |
Last Update Date | 2007-11-08 |