NPI | 1265821102 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OK 200129910A) |
Enumeration Date | 2015-01-15 |
Last Update Date | 2015-01-15 |