| NPI | 1144952466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2329925) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2329925) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11023286) | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2023-04-13 |