NPI | 1871486498 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261Q00000X Clinic/Center |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
261QM0850X Clinic/Center, Adult Mental Health | |
261QS0132X Clinic/Center, Ophthalmologic Surgery | |
Enumeration Date | 2025-06-02 |
Last Update Date | 2025-06-02 |