| NPI | 1083724231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ME AP091035) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 13528) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-10-14 |