| NPI | 1295082139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA rn2280625) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2280625) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2026-04-06 |