| NPI | 1215365382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2302584) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 2302584) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2302584) | |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2023-03-20 |