| NPI | 1730685561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209022669) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041.455247) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2021-05-15 |