| NPI | 1396114955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202204953NP-PP) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163W00000X Registered Nurse (Licence: OR 201502991RN) | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2022-05-02 |