| NPI | 1598482580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA APRN10003790) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2345699) |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2025-05-02 |