| NPI | 1932900396 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2391393) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163W00000X Registered Nurse (Licence: MA RN2391393) | |
| Enumeration Date | 2025-03-21 |
| Last Update Date | 2025-03-21 |