| NPI | 1992109466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209011782) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209011782) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2025-02-07 |