| NPI | 1861204745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE ETHIER Owner/Authorized Offical 508-422-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-01-27 |