| NPI | 1326066515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN160353) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA 160353) |
| 364S00000X Clinical Nurse Specialist (Licence: MA RN160353) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-07-22 |