| NPI | 1598327629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2274679) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2274679) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2274679) | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2021-01-14 |