| NPI | 1528497328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202005021NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95015182) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95135488) | |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2021-03-29 |