| NPI | 1770831281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 068141-23) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2281107) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2281107) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2021-03-18 |