| NPI | 1922479617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277000605) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 277000605) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2022-11-10 |