| NPI | 1952892739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MA RN2322157) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2322157) |
| Enumeration Date | 2018-05-28 |
| Last Update Date | 2020-04-24 |