| NPI | 1346770914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277001928) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209016243) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-05-18 |