NPI | 1780067645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2291563) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2291563) |
Enumeration Date | 2015-07-09 |
Last Update Date | 2020-07-07 |