| NPI | 1730623182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: TN 0000053847) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 9601022) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2023-06-02 |