| NPI | 1285303628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN02812) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI RN70087) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2337613) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA MA6746599) | |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2023-05-15 |