NPI | 1427394089 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN253818) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA 253818) |
Enumeration Date | 2012-12-28 |
Last Update Date | 2024-04-04 |