| NPI | 1245708239 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209019207) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2018039619) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G153333) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT APRN-197685) | |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2023-03-01 |