| NPI | 1235951153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI RN80447) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2333831) |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2025-03-14 |