| NPI | 1053830018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2310066) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2310066) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95007333) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95007333) | |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2023-11-07 |