| NPI | 1710394994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN03353) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2284853) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2284853) | |
| Enumeration Date | 2014-07-19 |
| Last Update Date | 2022-12-05 |