| NPI | 1568846236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP151032) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60555984) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60555984) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2018-07-10 |