| NPI | 1578446860 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2339348) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2339348) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2025-07-26 |
| Last Update Date | 2026-07-23 |