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 |