| NPI | 1336388677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 060533-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME RN53381) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP131088) | |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2023-12-06 |