| NPI | 1699420265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IL 209-024781) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IL 209-024781) |
| Enumeration Date | 2022-02-12 |
| Last Update Date | 2023-11-28 |