| NPI | 1700992948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD050742L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD050742L) |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 273R00000X Psychiatric Unit | |
| 282N00000X General Acute Care Hospital | |
| 283Q00000X Psychiatric Hospital (Licence: PA MD050742-l) | |
| 310400000X Assisted Living Facility | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 314000000X Skilled Nursing Facility | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-02-06 |