| NPI | 1558765164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209034652) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: IL 1011663) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2026-06-02 |