NPI | 1396051637 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201501392NP-PP) |
Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: MA RN2264824) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95001312) | |
364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: MA RN2264824) | |
Enumeration Date | 2010-08-24 |
Last Update Date | 2020-07-01 |