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