NPI | 1629550215 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201908982NP) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60896898) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 6148) | |
Enumeration Date | 2018-08-30 |
Last Update Date | 2024-03-12 |