NPI | 1215199351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2307298) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7468) |
163W00000X Registered Nurse (Licence: MA RN2307298) | |
Enumeration Date | 2008-06-30 |
Last Update Date | 2022-07-21 |