| NPI | 1114553898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202214981NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC 1024337) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024178703) | |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2026-06-02 |