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 |