| NPI | 1295322675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN264719) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 724276) |
| 163W00000X Registered Nurse (Licence: CT 87327) | |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2020-12-31 |