| NPI | 1629595053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209016381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041431700) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |