| NPI | 1295515211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10065099) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201800052RN) |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2026-08-04 |