| NPI | 1588458590 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.033097) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.529434) |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2025-09-26 |