| NPI | 1801601158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407511) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.032342) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11037670) | |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-09-17 |