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 | 2023-06-16 |