| NPI | 1487294559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: MA 2304438) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 2304438) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2025-03-30 |