| NPI | 1063996809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP181272) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9376950) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2021-03-30 |