| NPI | 1821441965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201706949NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 086468-23) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2023-03-13 |