| NPI | 1649460031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME 042387) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 065771-23) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2017-03-15 |