| NPI | 1780819110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP171130) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME R056280) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2021-06-18 |