| NPI | 1528686888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.025183) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041.476034) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041476034) | |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2022-08-01 |