| NPI | 1750106902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2364010) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MA RN2364010) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA RN2364010) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MA RN2364010) | |
| 2084P0805X (Licence: MA RN2364010) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MA RN2364010) | |
| 2084S0012X Psychiatry & Neurology, Sleep Medicine (Licence: MA RN2364010) | |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2024-11-21 |