| NPI | 1801311527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP191005) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F340905-1) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 340905) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME 191005) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2021-11-22 |