| NPI | 1013005792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR NP 091007250N6) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 001741) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-08-03 |