| NPI | 1578993887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10022754) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2276443) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2024-03-22 |