| NPI | 1548756794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP11403) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP11403) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209022157) | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2025-06-11 |