| NPI | 1497989669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201601235NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 06883923) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 18109NP) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2016-07-29 |