| NPI | 1861585036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP81900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME R054840) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A094979) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2017-12-04 |