| NPI | 1265198113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MA 2284570) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MA 2284570) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2024-09-10 |