| NPI | 1306274303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201708072NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 23793) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2021-07-29 |