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 | 2024-04-22 |