| NPI | 1861885675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 20912434) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209012434) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2018-07-06 |