NPI | 1073078366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202005741NP-PP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201809282RN) |
Enumeration Date | 2019-01-31 |
Last Update Date | 2020-07-14 |