| NPI | 1194869313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 17368) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 581556) |
| 163W00000X Registered Nurse (Licence: OR 202002074RN) | |
| 363L00000X Nurse Practitioner (Licence: CA 17368) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 17368) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 202004463NP-PP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202004463NP-PP) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2024-02-08 |