| NPI | 1699297648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: ME CNP161149) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: ME CNP161149) |
| 363L00000X Nurse Practitioner (Licence: ME CNP161149) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-09-06 |