| NPI | 1639223266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: AL 1520C) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: AL 1520C) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-09 |