| NPI | 1841706371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.017099) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: AL 1-144296) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041460500) | |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2018-02-08 |