| NPI | 1003969643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200750075NP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 200341326RN) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2021-01-13 |