| NPI | 1952879777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209018240) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 041337696) |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: IL 041337696) | |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2025-03-04 |