| NPI | 1083089866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209027225) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.428128) |
| Enumeration Date | 2015-12-05 |
| Last Update Date | 2023-08-11 |