| NPI | 1366859175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61421622) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201403830RN) |
| 171M00000X Case Manager/Care Coordinator | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10006901) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2025-08-26 |