| NPI | 1962879924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN216904) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 048270-21) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA 216904) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN216904) | |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2022-11-30 |