| NPI | 1902119522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: CO 53908) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ R72321) |
| Enumeration Date | 2010-07-24 |
| Last Update Date | 2014-07-08 |