| NPI | 1740446335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202114724NP-PP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 202114724NP-PP) |
| Enumeration Date | 2008-08-02 |
| Last Update Date | 2025-10-01 |