NPI | 1578107959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2269325) |
Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MA RN2269325) |
Enumeration Date | 2019-10-29 |
Last Update Date | 2025-03-17 |