| NPI | 1720502628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 111595-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP171069) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2026-01-15 |