| NPI | 1427095280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP131013) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 258647) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA 258647) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 258647) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP131013) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2013-11-15 |