| NPI | 1659151934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.029482) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041513378) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2024-10-09 |