| NPI | 1194797159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ME AP081487) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ME 038298) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: ME CNP81487) | |
| 363LF0000X Nurse Practitioner Family (Licence: ME CNP81487) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-12-28 |