| NPI | 1750689949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041.173569) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.011523) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2011-03-11 |