| NPI | 1356173124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IL 209.030398) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.505508) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-12-09 |