| NPI | 1245181684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 2025073757) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 2025073757) |
| Enumeration Date | 2026-02-03 |
| Last Update Date | 2026-02-04 |