| NPI | 1538779301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201805080RN) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHPC-001160) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2025-05-02 |