| NPI | 1982051959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 1982051959) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201603282NP-PP) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2024-11-14 |