| NPI | 1235832957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2334207) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MA RN2334207) |
| 163WG0000X Registered Nurse, General Practice (Licence: NH 086615-21) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 086615-23) | |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2025-07-07 |