| NPI | 1275767394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277000006) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041282033) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209007568) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2021-04-28 |