| NPI | 1346952603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10035532) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95025779) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95025779) | |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2026-02-24 |