| NPI | 1366435125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G115152) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149009939) |
| 1041C0700X Social Worker, Clinical (Licence: IA 06158) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IA 115152) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2021-04-21 |