| NPI | 1952876690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10034351) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201805408RN) |
| 363L00000X Nurse Practitioner (Licence: OR 1034351) | |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2024-12-09 |