| NPI | 1255508958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME RO-37631) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: ME 0372467) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2008-05-12 |