| NPI | 1487028361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202009010NP-PP) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2025-04-09 |