NPI | 1093241010 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN264251) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN264251) |
Enumeration Date | 2017-05-11 |
Last Update Date | 2024-05-06 |