| NPI | 1366269466 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209031001) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041489427) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 291077) | |
| Enumeration Date | 2024-09-21 |
| Last Update Date | 2025-01-10 |