NPI | 1255823779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CA 235524) |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CA 235524) |
Enumeration Date | 2018-05-31 |
Last Update Date | 2018-05-31 |