NPI | 1124124904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME R053512) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 0434312303) |
Enumeration Date | 2006-09-16 |
Last Update Date | 2007-07-08 |