| NPI | 1154998342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277002764) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 167322) |
| 163W00000X Registered Nurse (Licence: IL 041.429974) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G167535) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2024-06-23 |