| NPI | 1619518719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ME CNP221177) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2287373) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-05-18 |