| NPI | 1295048890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NY 003516) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: NY 003516) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2010-07-23 |