| NPI | 1801546692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP221394) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME RN68549) |
| 163W00000X Registered Nurse (Licence: MA RN2334521) | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2024-05-06 |