| NPI | 1821447608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404870) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 12411-MH-CC) |
| 163W00000X Registered Nurse (Licence: MA RN2349228) | |
| 163W00000X Registered Nurse (Licence: NY 878419) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2349228) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2349228) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-05-09 |