| NPI | 1427631944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ME CNP231702) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 29408) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2024-06-12 |