| NPI | 1245988484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202205309NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202205300RN) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1068282) | |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2023-04-12 |