| NPI | 1164194171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 2024009674) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202110540RN) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2024-07-02 |