NPI | 1467178566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MS 1699869537) |
Enumeration Date | 2022-10-19 |
Last Update Date | 2022-10-19 |