| NPI | 1508592080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2025038678) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CT 176152) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2026-02-26 |