NPI | 1477099935 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/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 |