| NPI | 1982248654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202213922NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201909164RN) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2022-09-09 |