| NPI | 1255127676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN10021172) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LCSW228617) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-04-15 |