| NPI | 1205577343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2328749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME RN76982) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-02-04 |