| NPI | 1548969454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2380369) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MD r210702) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2023-06-09 |