| NPI | 1861377814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 202008873RN) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10063021) |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2026-07-07 |