| NPI | 1265458905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201250120NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME R042339) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 0473272303) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2014-05-28 |