NPI | 1164194171 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10029068) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202110540RN) |
Enumeration Date | 2021-09-29 |
Last Update Date | 2024-09-19 |