| NPI | 1750829636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277003496) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132595) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2025-01-15 |