| 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 |