| NPI | 1164946760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| 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 | 2023-09-06 |