| NPI | 1083790554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 200242151 RN) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200250110NP) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2023-03-07 |