| NPI | 1982835526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301099983) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2014-01-29 |