| NPI | 1497946693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.018300) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209018300) |
| 171100000X Acupuncturist (Licence: IL 198.000715) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2024-10-23 |