| NPI | 1790872000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201250173NP) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OR 201042999RN) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2025-04-21 |