NPI | 1104880350 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP81591) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME 51968) |
Enumeration Date | 2006-04-14 |
Last Update Date | 2023-01-23 |