| NPI | 1437613882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: ME CNP211203) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R213763) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2021-08-12 |