NPI | 1013517341 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2284464) |
Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: MA RN2284464) |
163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: MA RN2284464) | |
163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2284464) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404793) | |
Enumeration Date | 2020-10-27 |
Last Update Date | 2024-04-11 |