| NPI | 1780481051 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 092322-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 092322-21) |
| 163W00000X Registered Nurse (Licence: MA RN2333857) | |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-03-13 |