| NPI | 1265656953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041-326520) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 105104) |
| 163WC0400X Registered Nurse, Case Management (Licence: IL 041-326520) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041.32650) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2009-04-14 |