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 |