| NPI | 1003236449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VT 101.0135723) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 12656) |
| 363L00000X Nurse Practitioner (Licence: ME CNP221589) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2025-11-21 |