| NPI | 1770872582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP111011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME RN57149) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2015-04-20 |