| NPI | 1760891337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ME CNP191045) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307029) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2020-09-30 |