| NPI | 1245719541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP181201) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME RN68863) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2020-03-03 |