| NPI | 1396945176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: PA SP032949) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: ME CNP181238) |
| 363L00000X Nurse Practitioner (Licence: PA SP009465) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: ME CNP181238) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: PA SP009465) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2025-08-01 |