| NPI | 1144639527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: IL 209.011662) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IL 209.011662) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2019-01-23 |