| NPI | 1346317799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 267650) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: MA 267650) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 267650) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-11-13 |