| NPI | 1669023347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277002526) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209020076) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 277002526) | |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2023-04-05 |