| NPI | 1558995217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10003518) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: OR 201242529RN) |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: WA RN60312665) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61364034) | |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2025-03-11 |