| NPI | 1659729176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: OH 80-000040) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: OH 80-000040) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2017-10-31 |