| NPI | 1457932337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71011081A) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IL 041354134) |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: IN 28230854A) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209023083) | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2023-06-14 |