| NPI | 1629620497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202113375NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95012965) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2026-04-08 |