| NPI | 1922660042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2024011384) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 277003193) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2019023256) | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2024-09-25 |