NPI | 1295879260 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN238327) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN238327) |
Enumeration Date | 2007-02-16 |
Last Update Date | 2021-05-17 |