| NPI | 1952754442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201701390NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 209338) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201701389RN) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR 201701390NPPP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 0000022011) | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2019-07-25 |