| NPI | 1922487370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209012902) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209012902) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2020-10-07 |