| NPI | 1407578313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10031841) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201709772RN) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2025-03-06 |