NPI | 1821735911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2344302) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2344302) |
Enumeration Date | 2022-05-19 |
Last Update Date | 2023-03-30 |