| NPI | 1477686855 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: MA 264734) | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 226142) | 
| Enumeration Date | 2007-03-14 | 
| Last Update Date | 2015-08-18 |