NPI | 1801188644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2270208) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2270208) |
Enumeration Date | 2011-05-12 |
Last Update Date | 2012-10-18 |