| NPI | 1497188106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.025514) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.524448) |
| 163W00000X Registered Nurse (Licence: NY 757959) | |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CO 198358) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 36768.1471) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0992019-NP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402523) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277.002535) | |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2023-05-08 |