| NPI | 1083844039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP151039) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 055013-23) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2016-09-27 |