| NPI | 1871695619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP81369) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME R028675) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-04-15 |