| NPI | 1922388420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2295821) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2295821) | |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2020-08-07 |