| NPI | 1376361287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209031238) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041375170) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-12-17 |