| NPI | 1104918796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP81743) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME RN41793) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2017-01-27 |