| NPI | 1649760083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277002403) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IL 209017357) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2023-08-08 |