| NPI | 1942623525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277000628) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041344165) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277000628) | |
| Enumeration Date | 2014-02-01 |
| Last Update Date | 2023-12-05 |