| NPI | 1871522615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ME CNP151098) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NH 046392-23-05) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2016-07-22 |