| NPI | 1225434020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10013304) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1630220) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2023-09-25 |