| NPI | 1215715982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G181050) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IA 159795) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041456018) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209030728) | |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2024-10-18 |