| NPI | 1326089483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005618) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ME AP111043) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 042823-23-03) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2014-02-20 |