| NPI | 1053720003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OR 201242490RN) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201242490RN) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2019-03-13 |