| NPI | 1720409394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202103126NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201504320RN) |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2024-02-29 |