| NPI | 1003315045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201900796NP-PP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN60364120) |
| 363L00000X Nurse Practitioner (Licence: OR 201900796NP-PP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201900796NP) | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2024-03-25 |