| NPI | 1427874247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2302790) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 130410) |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2025-09-02 |