| NPI | 1477686855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: CT 074012) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 226142) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2025-11-05 |