| NPI | 1013392141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201140102RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201140102RN) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2016-01-22 |