| NPI | 1497206817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2291351) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2291351) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2024-09-03 |