Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1134745417 |
---|---|
Provider Name | Thomas Joseph Nimrod |
First Address | Chicago, IL 60626-2263 |
Second Address | Chicago, IL 60611-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2020 |
Last Update Date | 22/06/2020 |