| NPI | 1558736736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277.000077) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 277.000077) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 277.000077) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2024-09-03 |