| NPI | 1003898677 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME AP081368) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME R034632) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2012-01-05 |