| 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 |