NPI | 1992390967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2264676) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI aprn03130) |
163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2264676) | |
Enumeration Date | 2021-03-02 |
Last Update Date | 2025-09-17 |