| NPI | 1225657604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 8036) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: ME CNP201108) |
| 363LF0000X Nurse Practitioner, Family (Licence: ME CNP201108) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2024-01-23 |