| NPI | 1295524932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: ME CNP241190) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: ME CNP241190) |
| Enumeration Date | 2025-04-30 |
| Last Update Date | 2025-05-20 |