| NPI | 1649228701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 0376062-34) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041-322947) |
| 363L00000X Nurse Practitioner (Licence: IL 209-004600) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-03-27 |