| NPI | 1477099935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209015000) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.015000) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2018-09-12 |