| NPI | 1780198192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.025433) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2024-03-15 |