| NPI | 1891220257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 309011447) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 041286056) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209015948) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2018-08-13 |