| NPI | 1093260622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201707152NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61256180) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95004776) | |
| 163W00000X Registered Nurse (Licence: OR 201606248RN) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61370238) | |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2023-11-01 |