| NPI | 1457744310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP171017) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5007446) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2343113) | |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2020-08-03 |