| NPI | 1295069573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: TX N5533) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD438403) |
| Enumeration Date | 2009-09-20 |
| Last Update Date | 2010-06-16 |