| NPI | 1497590640 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2322912) |
| Additional Taxonomies | 163WC1400X Registered Nurse, College Health (Licence: MA RN2322912) |
| 163WC1400X Registered Nurse, College Health (Licence: PA RN736350) | |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2024-06-28 |