| NPI | 1194499426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP201483) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: ME CNP201483) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2026-03-23 |