| NPI | 1164577524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: OR 83038439RN) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2009-02-05 |