| NPI | 1154007748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209028057) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 163W00000X Registered Nurse (Licence: IL 041483713) | |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2023-08-14 |