| NPI | 1316580905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2314446) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2314446) |
| 101YM0800X Counselor, Mental Health | |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: MA RN2314446) | |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2023-12-30 |