| NPI | 1295263515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN01722) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2330024) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 681574) | |
| 363LF0000X Nurse Practitioner, Family (Licence: RI APRN01722) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2330024) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2021-06-29 |