| NPI | 1346641644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209027126) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71005249A) |
| Enumeration Date | 2014-09-06 |
| Last Update Date | 2023-08-17 |