| NPI | 1730612417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2275698) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2275698) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2018-03-17 |