| NPI | 1194355578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MA RN2293449) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NH 067929-23) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2025-05-08 |