| NPI | 1205447455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP201467) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: ME P8036707) |
| 163W00000X Registered Nurse (Licence: ME RN72498) | |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2021-08-03 |