| NPI | 1689334369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2349307) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MA RN2349307) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11023942) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2349307) | |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2024-03-21 |