| NPI | 1164946760 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: ME CNP231149) | 
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 7117) | 
| Enumeration Date | 2017-07-26 | 
| Last Update Date | 2025-05-27 |