| NPI | 1619305521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 279930) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN279930) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2023-05-02 |