| NPI | 1699449082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP211177) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 202105402NP-PP) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-05-14 |