| NPI | 1053543066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201050130NP) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23426) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 200841283RN) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2019-07-29 |