| NPI | 1215423298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202101612NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61490835) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 202101612NP-PP) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2026-06-11 |