| NPI | 1922355411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201502356NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201502355RN) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2023-05-16 |