| NPI | 1447918065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP211421) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 087718-23) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2022-05-27 |