| NPI | 1164767471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0810X Clinical Nurse Specialist Psychiatric/Mental Health, Child & Family (Licence: MA RN2351706) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: MA RN2351706) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MA 1797) | |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2023-10-26 |