| NPI | 1043092307 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ME CNP231569) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: ME CNP231569) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: ME CNP231569) | |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2023-10-20 |