| NPI | 1932956190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2379255) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F406355) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 163W00000X Registered Nurse (Licence: MA RN2379255) | |
| 163W00000X Registered Nurse (Licence: NY 953211) | |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2026-01-04 |