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 |