| NPI | 1447366679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 8023) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: SC 8023) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2025-09-11 |