| NPI | 1316198872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200950172NP) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA CNS 3098) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP 18387) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2010-06-10 |