| NPI | 1245649029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201810942NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 53268) |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: OR 201402362RN) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2019-05-28 |