| NPI | 1326882267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP241755) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME 74465) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2025-01-27 |