| NPI | 1619115169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP201186) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME R054576) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2022-02-03 |