| NPI | 1588979553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201508082NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 17997) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA 1214) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2021-03-09 |