| NPI | 1609003102 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 242665) |
| Additional Taxonomies | 273R00000X Psychiatric Unit (Licence: MA 242665) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2021-01-27 |