| NPI | 1659090520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP221067) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 090378-23) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2023-04-19 |