| NPI | 1982336624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2340940) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN68930) |
| 163W00000X Registered Nurse (Licence: MA RN2340940) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN03024) | |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2025-04-11 |