| NPI | 1134755028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2270564) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2270564) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-02-09 |