| NPI | 1235410846 |
|---|---|
| Former Name | AMANDA ELISABETH MARTINO |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MA RN2268151) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2018-04-27 |