| NPI | 1881700532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD-070809-L) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA MD-070809-L) |
| 173000000X Legal Medicine (Licence: PA MD-070809-L) | |
| 174400000X Specialist (Licence: PA MD-070809-L) | |
| 273R00000X Psychiatric Unit (Licence: PA MD-070809-L) | |
| 283Q00000X Psychiatric Hospital (Licence: PA MD-070809-L) | |
| 310400000X Assisted Living Facility (Licence: PA MD-070809-L) | |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness (Licence: PA MD-070809-L) | |
| 3104A0630X Assisted Living Facility Assisted Living, Behavioral Disturbances (Licence: PA MD-070809-L) | |
| 314000000X Skilled Nursing Facility (Licence: PA MD-070809-L) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-04-15 |