NPI | 1346613718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277000068) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277000068) |
Enumeration Date | 2015-11-07 |
Last Update Date | 2023-05-17 |