| NPI | 1689160228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP221305) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022479) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2022-12-20 |