| NPI | 1770125908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277002326) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28231903A) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2026-08-13 |