| NPI | 1457659518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2307297) |
| Additional Taxonomies | 101Y00000X Counselor |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2307297) | |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2022-02-03 |