| NPI | 1457584740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209011136) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041416468) |
| 163W00000X Registered Nurse (Licence: IA 135784) | |
| 163W00000X Registered Nurse (Licence: TN 190078) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2013-12-30 |