NPI | 1902154438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2348275) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 118997) |
Enumeration Date | 2012-08-15 |
Last Update Date | 2023-03-30 |