| NPI | 1316080195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 276400000X Rehabilitation, Substance Use Disorder Unit |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MA 205807) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 205807) | |
| 363L00000X Nurse Practitioner (Licence: MA 205807) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2012-09-07 |