| NPI | 1174852784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: ME CNP161141) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA 278737) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2017-04-24 |