| NPI | 1245698471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202209936NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9345457) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9345457) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 6102) | |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2023-09-22 |