| NPI | 1972696037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD422537) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA MD422537) |
| 283Q00000X Psychiatric Hospital | |
| 174400000X Specialist | |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-02-06 |