| NPI | 1215152632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2264377) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 213256) |
| 1041C0700X Social Worker, Clinical (Licence: MA 114229) | |
| 163W00000X Registered Nurse (Licence: MA RN2264377) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2022-08-03 |