| NPI | 1013214337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2326403) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MA LN85190) |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2022-10-20 |