| NPI | 1588286983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2275860) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2275860) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2275860) | |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2023-08-21 |