NPI | 1770991218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2326656) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 120185) |
163W00000X Registered Nurse (Licence: MA RN2326656) | |
Enumeration Date | 2014-07-29 |
Last Update Date | 2020-02-10 |