| NPI | 1750046439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ME RN86678) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: ME LPN14614) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2024-01-02 |