NPI | 1740635283 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2015020950) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH APRN064237-23) |
Enumeration Date | 2016-05-03 |
Last Update Date | 2024-02-27 |