| NPI | 1518608256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2293214) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 2293214) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-07-11 |