| NPI | 1972921781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME157838) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9340017) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9340017) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2023-12-06 |