NPI | 1407209620 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 253J00000X Foster Care Agency |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2292446) |
Enumeration Date | 2016-07-22 |
Last Update Date | 2025-06-27 |