NPI | 1639907512 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209030321) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041489081) |
Enumeration Date | 2024-07-23 |
Last Update Date | 2024-08-20 |