| NPI | 1932719135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2365217) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71010501A) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ND R43593) | |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2023-12-12 |