| NPI | 1073796751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200950073NP) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OR 200743382RN) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2013-10-30 |