| NPI | 1477132538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 073337-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2303975) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2303975) | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2022-04-28 |