| NPI | 1922305978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201707205NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00176573) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95003416) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 60621382) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2021-07-19 |