| NPI | 1033233754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME R044772) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 058123-23) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-01-10 |