| NPI | 1396999421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10058927) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OR 200840542RN) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2026-06-20 |