| NPI | 1023372117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP121035) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME 21443315) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2013-12-18 |