| NPI | 1235632597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 7667) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60466387) |
| 163W00000X Registered Nurse (Licence: MN 2484456) | |
| 163W00000X Registered Nurse (Licence: OR 201802244RN) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201804484NP-PP) | |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2022-10-26 |