| NPI | 1487389177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10049537) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202210391RN) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2025-09-15 |