| NPI | 1346694353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 8573) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP151195) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2020-06-18 |