| NPI | 1669898268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201905019NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95001713) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201904695RN) | |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2021-03-18 |