| NPI | 1871828517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201150058NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 47055) |
| 163W00000X Registered Nurse (Licence: OR 099007862RN) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 111069) | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2023-03-07 |