| NPI | 1326424466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: RI APRN02395) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CT 46.002802) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: RI 02395) | |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2020-07-24 |