NPI | 1083145262 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277000273) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209.15779) |
Enumeration Date | 2017-03-21 |
Last Update Date | 2022-08-31 |