| NPI | 1336219286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: CT 001711) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CT 001711) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2011-07-01 |