| NPI | 1013353523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201242380RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201242380RN) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2013-09-03 |