| NPI | 1851804033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 8216) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WI 219649-30) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 8216-33) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277.003713) | |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2025-05-22 |