| NPI | 1053806653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201905497NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201341253RN) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2019-10-21 |