| NPI | 1528609567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP191227) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 111213-23) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2024-06-03 |