| NPI | 1750181459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MA RN2325346) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2325346) |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-07-26 |