| NPI | 1043189400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209033806) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 17589-33) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 1001340-NP) | |
| Enumeration Date | 2025-11-04 |
| Last Update Date | 2025-11-24 |