| NPI | 1730072711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP251322) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: ME CNP251322) |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-12-17 |