| NPI | 1235625294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0134647) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN59425) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN01843) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2022-04-28 |