| NPI | 1831411610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2284856) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2284856) | |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2015-01-09 |