| NPI | 1699904102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP131095) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC12020) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2015-04-16 |