| NPI | 1134613185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN2287796) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ME CNP181031) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-12-26 |