| NPI | 1356925440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 2023032820) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 2021013060) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2025-02-05 |